The Technology Informatics Guiding Education Reform (TIGER) Initiative

hello my name is Steve Lee and president and CEO of hims and today we have Michelle prosit with us to talk about the tiger initiative this is a program that's been a part of hims for a number of years and over the course of the next few minutes Michelle is going to tell us a little bit more about the startup of tiger what its objectives are how well it's performing and what the future holds for us as it relates to the tiger initiative Michelle is the chief professional practice officer at Elsevier clinical solutions she's also the recipient of the 2014 hims nursing informatics leadership award so Michelle thanks for being with us today and please learn a little bit about Tiger Tigers history and and what we ought to know in terms of some background about this initiative absolutely so the tiger initiative was actually born in about 2005 and how it came to be was when President Bush declared 2004 the decade of healthcare technology and appointed dr. Brailler as the first ONC czar and we had the first meeting in Washington DC and as they let out the federal framework for health information technology there were many of us there that recognized the nursing wasn't mentioned so it was kind of like an immediate reaction like my goodness if we're going to talk about putting health information technology throughout the country we definitely have nurses at the table because as you know nurses are the largest workforce in the United States and we recognized we had a lot of awareness to bring to that and to get them engaged so what happened was is there was some leaders that came together and said we've got to do something and out of that came an initiative called tiger and we had a meeting at Johns Hopkins School of Nursing and we set up a vision in a mission and the first thing we decided was we have to have a summit in which to bring nursing leadership together to really kick this off so that's what happened I was privileged to be the chair of that summit and we had about 120 nursing leaders from around the country in industry government education we engaged funding from the Robert Wood Foundation and other funding sources hims was a big supporter of Elsevier has always been a big supporter and out of that came a 10-year vision in a three year action plan that really kicked Tiger off and it was tremendously successful so let's go back to 2004 those startup days well how would you describe nursing as it relates to informatics back then because I'm kind of guessing that Tiger was designed to also help nurses out not only was Nursing not mention it at the table but I'm betting there was a need in education and curriculum and such in preparing nurses for this new world of informatics absolutely so at that point in time there was great inconsistency and what curriculums were doing with informatics there was a recognition we didn't really have a core set of competencies that throughout education as well as even on the practice side were nurses at the table as they were selecting health information technology did they have a voice in the design of it and so we recognized there was it's almost like we had to get our act together yeah we had a bring nursing leadership together we had to really make sure that we were making a space for nurses to really grasp technology and we were very intentional – about curriculum and education and practice and we knew we had to do it in both places and so we did have Tiger leaders representing all of those spaces also part of the summit we really sought out you know the emergency nurse Association the oncology and try to get everyone that really represented corner Seng practice to be there as well so that was an important part of it that would be expanding that group in getting bigger and broader engagement so now let's fast-forward some 12 years so what's your assessment of what Tigers accomplished what's the situation what's the status of Nursing and the nursing community today as it relates to informatics well so now 12 years later Tiger has grown tremendously this is my little tiger here but they're really theirs and there's Tigers all over the place that's what's so exciting so in that period of time we after the summit we launched a collaborative and we took core issues that came out of that summit and we put teams of nurses together and we developed reports standard and usability we did report virtual platforms where we could learn together we did one on faculty development what do we need to do for that there was several reports that were done and and then we really moved into having to move Tiger into some type of form where it was owned by somebody because remember this was all volunteers over 1500 volunteers and at that point time is when we really approached him and said is there a way we can work together to give some to give some structure to Tiger we became part of the foundation and then in 2015 moved Tiger officially under hims as a committee so what has happened in that time is it has grown immensely and two of the hallmark efforts that have happened is we have grown internationally so Tigers we have Tigers all around the world now not just here in the United States in North America and we realized we needed to make an interprofessional so talk a little bit about that intra professional or interprofessional approach in terms of how that's changed the way you're working how you're engaging people differently and how's that changed your objectives so I think the objectives are probably pretty similar in that we all want informatics to be core in our practice and to help us regardless of what kind of clinician you are exactly so I think that piece is very much the same and I think what's different is moving out of silos though so we recognize that it's important to really have people on the tegra committee that represent not only different disciplines such as you know beyond nursing and to have physicians pharmacists dieticians different clinicians involved but also interprofessional as far as Public Health and different expertise like that so it is no longer just a nursing committee so we worked how we've recruited we've gotten great how're we doing in terms of bringing the other prefer wages there's our readiness there you also mentioned the establishment of an International Committee in 2012 so where are we are there differences in how you engage clinicians in Asia versus Europe or North America so talk a little bit about the international expansion and what your experiences have been there sure and actually the work has really helped us find out what are the differences so again when you're in the I think we started out in the nursing community because informatics is global there was a lot of interest from nurses in other countries of what we were doing and and so as Tiger grew we actually formed an inter international like sub group to begin talking about how we could expand it and in 2015 it really took off we had 21 countries that want to be part of international Tiger and they came together and they said you know this is a global issue why should we just do this one country at a time so we started the compas competency synthesis project and that is being led by dr. Ursula uber out of Germany 21 countries volunteered and we did things like develop use cases so we could learn from each other what are you doing in your country what are you doing your country they did a they did an international survey to find out what patterns were in their competencies and and then are in the process of doing a harmonization table so in essence and I just saw this presented their work presented at ni 2016 in Geneva the outcome of this is now we have a picture of what are the competencies that are needed which countries are strong in what areas which are really weak and our goal now is to move into a globalised informatics competency and that to inform curriculum so we can really start to have a standard if you will around informatics compass now do those competencies vary any by scope of practice differences in different parts of the world I suspect there are and I don't have the data right in front of me but there were areas where there were differences and I and so I think in addition to the competencies it will help inform what is practice really like in that in that country about the top of my head I can't remember the details but but I also like what you said in terms of it helped you and and Tiger as a group learn about differences in all and and then coming up with this sort of blueprint or mapping of competencies and strengths and some countries weaknesses and others how are we aligning for example in hims how are we aligning our educational programming to meet those gaps in terms of competencies so we're doing education and I think looking at different programs obviously informatics programs but also out of Tiger I think one of the benefits was the birth of a virtual learning environment so we actually have a platform which we can help people learn and get access to resources to help with those confidences as well so the virtual learning environment actually is powered by hims and you actually can go in and get access to the the project the synthesis project but also a lot of other educational material to help really in like this webinars or webinars white papers recorded presentation and again it's the whole intention is to increase the competency of clinicians through the tiger initiative now the virtual learning environment is is actually absolutely fantastic in terms of being able to provide distance learning because we do events around the world and it's great for people to come those but not everybody can so we seen good uptake in terms of the virtual learning environment in terms of people accessing yep we are and what's really exciting is now we're seeing we're seeing it being used by organizations as a training tool to work for door closes yes no and and we've been approached by schools we've been approached by healthcare systems that say I don't have we don't have the bandwidth to do this you already have the learning platform how can we work with Tiger to actually so we have had some pilot school go on with large healthcare systems and I think this will continue to grow as organizations have to assure their staff that their bedside clinicians have to have these competencies as well and so it's just it seems like it's so innovative like someone will use it then they'll have another idea then they'll have another idea and it could go a lot of different directions I think it's very exciting excellent now for our viewers not to put you on the spot but do you know offhand what the address is for them to access the virtual learning environment so anyone watching our broadcast here will know where to go because it is what's wwm z org slash tiger perfect and and from there we'll get to screen from there you'll get to the tiger main the main screen and you can get a link to the VLE the other thing too is a lot of great information would encourage everyone to sign up for the tiger newsletter that comes out and that has a lot of information of what Tiger is doing but just excellent educational material is that sign up free in terms of the newsletter yeah there's a listserv newsletters free and then the access to the VLE is also on that website excellent have you been able to do any of this in languages other than English oh well we are taking some of the competency work and we are working it's starting to translate that is another intention of the international group we've got 21 countries involved and so yeah we're going to have some volunteers who have the language experience to be able to translate this because that's an important resource to be limited only to English readers and listeners so that that's excellent I understand that Tiger recently published an informatics definitions document can you share a little bit of information about that documents intention and how to access it I sure can haha because I myself and Marion Ball were the co-chairs of the new Tiger Committee for the last two years and that was a major endeavor that we went through with it with the new interprofessional committee and we as we came together as this committee now under hims one of the things that again the leaders on the committee identified is there's all these different terminologies around informatics and so they decided the first collective work they wanted to do together was to come up with health informatics definitions so that it was a resource and the committee worked on that for about a year we just recently published it so it's on the tiger website you go and it has common term indefinite backed up by links to the sources so as we're trying to raise that awareness about informatics Tiger could be another source for people to go to and they can use it in their school they can use it at work but we do have this common document that we're quite proud of now on the Tiger website you know we're taping this at the hemes asia-pacific conference so what can you tell us that's going on out in the asia-pacific region more specifically in terms of where we're active places where we might be looking to expand the activity and get more people involved what can you tell us about what's going on out in this region well there are several countries in Asia Pacific that are engaged through the you know through the International Work Australia New Zealand Japan there are there several dr. pol and Chun who is from Taiwan has really been kind of like the ringleader for this area and he is working also very much to engage a China so he's already done some translation of some of the Tiger work out of China and I think it continues to be an area where we really want to grow Tiger in the specific region in Asia pact and we've we've had some strong Tiger leaders that have been with it from really for many many years under kind of under his ring icon the ring leader to get more people involved so there is engagement and then we're looking to expand it as well great yeah are you seeing an uptake in the interprofessional engagement in Asia is it still more of a nursing focus that's the status fixed I would say it's still more nursing focused at this point in time and it's it's kind of like technology you know you see it in one place and you go to another area it's almost like watching it happen all over again yeah so I feel like we're kind of there right now getting the nurses really strong and then the interprofessional aspect will probably be a second wave in those countries is probably a cycle that is going to repeat itself is that you have a core audience that really gets invested and develops the tools and resources and then you start expanding that circle out to other disciplines and you'll fine that and then certainly as you mentioned in People's Republic China language is going to be a significant barrier and challenge yep language and and finances are two big barriers and that that region when you think about curricula and what is being offered today are we there in terms of getting informatics firmly embedded in curriculum are there holes are there parts of the world where you see greater need for further development sort of wrap us up here in terms of where we are in preparing professionals for a career in healthcare which obviously requires a deep understanding of informatics yeah obviously I think we have made great progress over the last 12 years and I think that you know one of our goals was to have it be just integrated and can kind of get away from teaching one course on informatics so we certainly have had curriculums that have really embraced it and have looked at it everything from you know simulation to how they teach it throughout their curriculum I wouldn't say probably across the board that's consistent everywhere but I think the tiger initiative has made a great impact impact in that and then I think the other thing that's starting to happen which I think is very exciting is also bringing together practice in the academic settings together in simulation so that we're really starting to bridge that gap as well I think there will be another advancement where when Tiger first started that really wasn't so much so so we have made progress that's outstanding it really is so important and we all that are close to and understand the very close relationship between clinical practice and informatics and not having that educational preparation in order to do our jobs well utilizing the tool right that are part of health care and clinical delivery really puts people at a disadvantage so I congratulate you and the tiger teams around the world for really bringing this to all of us being a part of the hems organization it's a wonderful asset for us to have as part of the programs and so I do I thank you for all your service in making this possible and we thank you because really we've always say Tiger has a home now and it's been a great relationship so it will only go up from here excellent you

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